Danon Disease Treatment & Management
- Author: Keith K Vaux, MD; Chief Editor: Maria Descartes, MD more...
Patients with Danon disease require frequent follow-up, with particular attention to the potential for atrial or ventricular arrhythmias and congestive heart failure (CHF). As is recommended in patients with hypertrophic cardiomyopathy (HCM), a ventricular septal thickness more than 30 mm is considered a risk factor for a life-threatening event, particularly in this group of patients who often have a poor prognosis for survival beyond their teenage years.
An implantable cardioverter-defibrillator (ICD) may be indicated. However, in Maron’s study, all 7 patients had ICDs and 5 had lethal arrhythmias that did not convert with ICD therapy. However, not all of those patients died from the arrhythmia. In addition, 4 of those 7 actually died of CHF. CHF must be treated according to the hemodynamic cause for the symptoms. For example, patients with HCM have a relatively restrictive physiology with diastolic dysfunction and should be treated accordingly (ie, improving ventricular filling, improved heart rate control, sinus rhythm maintenance, improved diastolic relaxation); whereas, those with a dilated form of cardiomyopathy tend to have a systolic dysfunction problem that may require different treatment (ie, improved afterload reduction and increased contractility).
Several surgical interventions should be considered in patients with Danon disease. The proper timing of any of these interventions is not known; however, the risk of sudden death in teenage male patients appears to be substantial. This risk may influence decisions about the timing of surgical interventions.
- Implantable loop recorder (ILR)
- This device is implanted under the skin to record any arrhythmias that may happen when cardiovascular symptoms occur.
- The usual indication is an assessment of severe symptoms that occur too infrequently to be recorded by using conventional, external event recorders.
- The battery in one device (Reveal Plus; Medtronic, Minneapolis, MN) lasts for 14 months. It can be automatically activated when the programmed parameters of the device are satisfied. It can also be activated when the patient has symptoms. An activator that the patient carries is placed over the device, and a button is pushed to activate the ILR.
- ICD placement
- After Danon disease and severe hypertrophic changes of the heart are diagnosed, placement of an ICD should be considered. For patients who have the dilated form of cardiomyopathy, ICDs may be indicated because of the degree of their dysfunction and their history of arrhythmias.
- Recommendations from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) trial apply to these patients.
- Furthermore, if the degree of CHF has progressed to New York Heart Association class III or IV with maximal medical therapy (eg, beta-blockers, afterload reduction, spironolactone, diuretics), placement of a biventricular pacing system, usually a biventricular ICD, should be considered.
- Cardiac transplantation
- Several reports mention patients with Danon disease who underwent cardiac transplantation.[20, 14, 11, 24, 15]
- Cardiac transplant should be considered as long-term treatment because the life expectancy is short. Consideration of cardiac transplantation is necessary because of the limited life expectancy of teenaged male patients, who have a high incidence of sudden death. Maron et al even recommend consideration of early transplant.
- In addition, female patients may need a cardiac transplant because they are not expected to live past their fifth decade.
- Cardiac transplantation is a reasonable treatment for Danon disease despite the presence of muscular problems because the neurologic disability or problems are mild.
Because of the severe nature of this disease and the short life expectancy in male patients, extensive counseling and education with the patient and family is important. When an ICD or cardiac transplantation is contemplated, psychiatric counseling may be needed. Dealing with these issues may be particularly challenging if the patient has clinically significant mental retardation.
Consultation with a neurologist is recommended to assess the degree of skeletal myopathy and cognitive deficiencies.
Genetic consultation regarding molecular testing and genetic counseling is important.
For the most part, no dietary restrictions are necessary for Danon disease. However, when the patient has symptoms of CHF, sodium restriction may be beneficial. Caffeine can potentially aggravate any underlying tachyarrhythmia.
Competitive athletic activity should be restricted for individuals with Danon disease and cardiomyopathy as recommended in the 36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities. Exceptions include activities classified as I-A, which include low-intensity sports with low static and low dynamic components, such as billiards, bowling, or golf.
As for noncompetitive activity, leisurely activities (eg, using an exercise bike or treadmill, playing doubles tennis, cycling at low intensity) are permitted in patients with HCM. The premise is that patients engaging in low-intensity activities are more apt than others to respond to the onset of warning symptoms.
From a neurologic standpoint, male patients with Danon disease may exercise the skeletal muscles. However, they should avoid excessive fatigue, which could cause muscle injury.
Arad M, Maron BJ, Gorham JM, et al. Glycogen storage diseases presenting as hypertrophic cardiomyopathy. N Engl J Med. 2005 Jan 27. 352(4):362-72. [Medline].
Danon MJ, Oh SJ, DiMauro S, et al. Lysosomal glycogen storage disease with normal acid maltase. Neurology. 1981 Jan. 31(1):51-7. [Medline].
Morisawa Y, Fujieda M, Murakami N, et al. Lysosomal glycogen storage disease with normal acid maltase with early fatal outcome. J Neurol Sci. 1998 Oct 8. 160(2):175-9. [Medline].
Sugie K, Yamamoto A, Murayama K, et ak. Clinicopathological features of genetically confirmed Danon disease. Neurology. 2002 Jun 25. 58(12):1773-8. [Medline].
Hashem SI, Perry CN, Bauer M, et al. Brief Report: Oxidative Stress Mediates Cardiomyocyte Apoptosis in a Human Model of Danon Disease and Heart Failure. Stem Cells. 2015 Jul. 33 (7):2343-50. [Medline]. [Full Text].
Hedberg Oldfors C, Mathe G, Thomson K, et al. Early onset cardiomyopathy in females with Danon disease. Neuromuscul Disord. 2015 Jun. 25 (6):493-501. [Medline].
Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation. 1995 Aug 15. 92(4):785-9. [Medline].
Charron P, Villard E, Sebillon P, et al. Danon's disease as a cause of hypertrophic cardiomyopathy: a systematic survey. Heart. 2004 Aug. 90(8):842-6. [Medline].
Nishino I, Fu J, Tanji K, et al. Primary LAMP-2 deficiency causes X-linked vacuolar cardiomyopathy and myopathy (Danon disease). Nature. 2000 Aug 24. 406(6798):906-10. [Medline].
Yang Z, McMahon CJ, Smith LR, et al. Danon disease as an underrecognized cause of hypertrophic cardiomyopathy in children. Circulation. 2005 Sep 13. 112(11):1612-7. [Medline].
Riggs JE, Schochet SS, Gutmann L, et al. Lysosomal glycogen storage disease without acid maltase deficiency. Neurology. 1983 Jul. 33(7):873-7. [Medline].
Byrne E, Dennett X, Crotty B, et al. Dominantly inherited cardioskeletal myopathy with lysosomal glycogen storage and normal acid maltase levels. Brain. 1986 Jun. 109 (Pt 3):523-36. [Medline].
Lacoste-Collin L, Garcia V, Uro-Coste E, et al. Danon's disease (X-linked vacuolar cardiomyopathy and myopathy): a case with a novel Lamp-2 gene mutation. Neuromuscul Disord. 2002 Nov. 12(9):882-5. [Medline].
Maron BJ, Roberts WC, Arad M, Haas TS, Spirito P, Wright GB. Clinical outcome and phenotypic expression in LAMP2 cardiomyopathy. JAMA. 2009 Mar 25. 301(12):1253-9. [Medline].
van der Kooi AJ, van Langen IM, Aronica E, van Doorn PA, Wokke JH, Brusse E. Extension of the clinical spectrum of Danon disease. Neurology. 2008 Apr 15. 70(16):1358-9. [Medline].
Fanin M, Nascimbeni AC, Fulizio L, Spinazzi M, Melacini P, Angelini C. Generalized lysosome-associated membrane protein-2 defect explains multisystem clinical involvement and allows leukocyte diagnostic screening in Danon disease. Am J Pathol. 2006 Apr. 168(4):1309-20. [Medline].
Spinazzi M, Fanin M, Melacini P, Nascimbeni AC, Angelini C. Cardioembolic stroke in Danon disease. Clin Genet. 2008 Apr. 73(4):388-90. [Medline].
Prall FR, Drack A, Taylor M, Ku L, Olson JL, Gregory D. Ophthalmic manifestations of Danon disease. Ophthalmology. 2006 Jun. 113(6):1010-3. [Medline].
Dworzak F, Casazza F, Mora M, et al. Lysosomal glycogen storage with normal acid maltase: a familial study with successful heart transplant. Neuromuscul Disord. 1994 May. 4(3):243-7. [Medline].
Majer F, Pelak O, Kalina T, et al. Mosaic tissue distribution of the tandem duplication of LAMP2 exons 4 and 5 demonstrates the limits of Danon disease cellular and molecular diagnostics. J Inherit Metab Dis. 2014 Jan. 37(1):117-24. [Medline].
Nucifora G, Miani D, Piccoli G, Proclemer A. Cardiac magnetic resonance imaging in Danon disease. Cardiology. 2012. 121(1):27-30. [Medline].
Laforet P, Charron P, Maisonobe T, et al. Charcot-Marie-Tooth features and maculopathy in a patient with Danon disease. Neurology. 2004 Oct 26. 63(8):1535. [Medline].
Echaniz-Laguna A, Mohr M, Epailly E, et al. Novel Lamp-2 gene mutation and successful treatment with heart transplantation in a large family with Danon disease. Muscle Nerve. 2006 Mar. 33(3):393-7. [Medline].
Chen XL, Zhao Y, Ke HP, Liu WT, Du ZF, Zhang XN. Detection of somatic and germline mosaicism for the LAMP2 gene mutation c.808dupG in a Chinese family with Danon disease. Gene. 2012 Oct 10. 507(2):174-6. [Medline].
Hong D, Shi Z, Wang Z, Yuan Y. Danon disease caused by two novel mutations of the LAMP2 gene: implications for two ends of the clinical spectrum. Clin Neuropathol. 2012 Jul-Aug. 31(4):224-31. [Medline].
Cheng Z, Fang Q. Danon disease: focusing on heart. J Hum Genet. 2012 Jul. 57(7):407-10. [Medline].
Froissart R, Maire I. Danon Disease. Orphanet Encyclopedia. 2002. [Full Text].
Konecki DS, Foetisch K, Zimmer KP, Schlotter M, Lichter-Konecki U. An alternatively spliced form of the human lysosome-associated membrane protein-2 gene is expressed in a tissue-specific manner. Biochem Biophys Res Commun. 1995 Oct 13. 215(2):757-67. [Medline].
Furuta K, Yang XL, Chen JS, Hamilton SR, August JT. Differential expression of the lysosome-associated membrane proteins in normal human tissues. Arch Biochem Biophys. 1999 May 1. 365(1):75-82. [Medline].
Tachi N, Tachi M, Sasaki K, et al. Glycogen storage disease with normal acid maltase: skeletal and cardiac muscles. Pediatr Neurol. 1989 Jan-Feb. 5(1):60-3. [Medline].
Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000 Jun 15. 342(24):1778-85. [Medline].
[Guideline] Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005 Jan 20. 352(3):225-37. [Medline].
Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003 May 28. 289(20):2685-94. [Medline].
Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. 2005 Apr 19. 45(8):1340-5. [Medline].
Maron BJ, Chaitman BR, Ackerman MJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004 Jun 8. 109(22):2807-16. [Medline].
Stuberg WA. Muscular dystrophy and muscular atrophy. Campbell SK, Vander Linden DW, Palisano RJ, eds. Physical Therapy for Children. 3rd ed. Philadelphia, Pa: WB Saunders; 2005. 421-52.
Maron BJ, Estes NA 3rd, Maron MS, Almquist AK, Link MS, Udelson JE. Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy. Circulation. 2003 Jun 17. 107(23):2872-5. [Medline].
Kashio N, Usuki F, Akamine T, et al. Cardiomyopathy, mental retardation, and autophagic vacuolar myopathy. Abnormal MRI findings in the head. J Neurol Sci. 1991 Sep. 105(1):1-5. [Medline].